Provider Demographics
NPI:1639414832
Name:ADAMS, MELISSA (BSN, HC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BSN, HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0354
Mailing Address - Country:US
Mailing Address - Phone:850-723-4109
Mailing Address - Fax:
Practice Address - Street 1:1390 FORT PICKENS RD
Practice Address - Street 2:#109
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-5129
Practice Address - Country:US
Practice Address - Phone:850-723-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education